About atopic dermatitis

What is atopic dermatitis?

Atopic dermatitis facts

  • Atopic dermatitis is a type of eczema.
  • The disease may be inherited and genetically determined.
  • The patient's skin may be "super sensitive" to many irritants.
  • Dry, scaly patches develop in a characteristic distribution.
  • Itching varies but may be intense and scratching hard to resist.
  • Scratching can cause skin thickening and darkening and lead to further complications, including bacterial infection.
  • Extremely dry skin can break down and ooze or weep.
  • If the itch can be controlled, the rash (which is aggravated by vigorous scratching) may be more readily treated.
  • Treatment of atopic dermatitis is centered around rehydrating the skin with emollients like petroleum jelly and cautiously using topical steroids to reduce inflammation and itching.
  • Oral antihistamines may be helpful in breaking the "itch-scratch" cycle.
  • Since secondary infections can aggravate the rash, topical or oral antibiotics may also be occasionally indicated.

What is atopic dermatitis?

Atopic dermatitis is a common, often long-lasting skin disease that affects a large percentage of the world's population. It is a special type of hypersensitivity that includes asthma, inhalant allergies (hay fever), and a chronic dermatitis (eczema). There is a known hereditary component of the disease, and it is more common in affected families. Criteria that enable your doctor to diagnose it include the typical appearance and distribution of the rash in a patient with a personal or family history of asthma and/or hay fever.

The term atopic is from the Greek meaning "strange." The term dermatitis means inflammation of the skin.

In atopic dermatitis, the skin becomes extremely itchy and inflamed, causing redness, swelling, vesicle formation (minute blisters), cracking, weeping, crusting, and scaling. This type of eruption is termed eczematous. In addition, dry skin is a very common complaint in almost all those afflicted with atopic dermatitis.

Although atopic dermatitis can occur in any age, most often it affects infants and young children. Occasionally, it may persist into adulthood or may actually appear at that time. Some patients tend to have a protracted course with various ups and downs. In most cases, there are periods of time when the disease is worse, called exacerbations or flares, which are followed by periods when the skin improves or clears up entirely, called remissions. Many children with atopic dermatitis enter into a permanent remission of the disease when they get older, although their skin may remain somewhat dry and easily irritated.

Multiple factors can trigger or worsen atopic dermatitis, including low humidity, seasonal allergies, exposure to harsh soaps and detergents, and cold weather. Environmental factors can activate symptoms of atopic dermatitis at any time in the lives of individuals who have inherited the atopic disease trait.

What is the difference between atopic dermatitis and eczema?

Eczema is a nonspecific term for many types of skin inflammation (dermatitis). There are different categories of eczema, which include allergic, contact, irritant, and nummular eczema, which can be difficult to distinguish from atopic dermatitis. These types of eczema are listed and briefly described below. Atopy is a medical syndrome that includes three associated conditions that tend to occur in the same individual: atopic dermatitis, inhalant allergies, and asthma. All three components need not be present in the same individual simultaneously.

Types of eczema

  • Contact eczema: a localized reaction that includes redness, itching, and burning where the skin has come into direct contact with an irritant such as an acid, a cleaning agent, or other chemical.
  • Allergic contact eczema: a red, itchy, weepy reaction where the skin has come into contact with a substance that the immune system recognizes as foreign, such as poison ivy or certain preservatives in creams and lotions like Neosporin or bacitracin (Baciguent)
  • Seborrheic eczema (also called seborrheic dermatitis or seborrhea) is a very common form of mild skin inflammation of unknown cause that presents as yellowish, oily, scaly patches of skin on the scalp, face, ears, and occasionally other parts of the body. Often this is also called dandruff in adults or "cradle cap" in infants.
  • Nummular eczema: coin-shaped (round), isolated patches of irritated skin -- most commonly on the arms and lower legs -- that may be crusted, scaling, and extremely itchy
  • Lichen simplex chronicus (localized neurodermatitis): a dermatitis localized to a particular anatomical area induced by long-term rubbing, scratching, or picking the skin. The underling cause may be a sensitivity or irritation that sets off a cascade of repeated itching and scratching cycles. It may be seen as scratch marks and pick marks. Areas of thickened plaques form on the skin of the neck, shins, wrists, or forearms. This condition has certain similarities to calluses, and it will resolve if the patient stops irritating the area.
  • Stasis dermatitis: a skin irritation on the lower legs, generally related to circulatory problems and congestion of the leg veins. It may have a darker pigmentation, light-brown, or purplish-red discoloration from the congestion and back up of the blood in the leg veins. It's sometimes seen more in legs with varicose veins.
  • Dyshidrotic eczema: irritation of the skin on the palms of hands (mostly) and less commonly soles of the feet characterized by clear, very deep-seated blisters that itch and burn. It's sometimes described as a "tapioca pudding"-like rash on the palms.
  • Xerotic eczema: areas of very dry skin most often seen on the lower legs of the elderly

What are the symptoms for atopic dermatitis?

Inflammation caused by atopic dermatitis can cover large areas of the body, such as the chest, or be limited to a few small locations.

Infantile eczema

In infants, atopic dermatitis (infantile eczema) usually appears as red, Itchy patches that are associated with very dry skin.

Atopic dermatitis (eczema) signs and symptoms vary widely from person to person and include:

  • Dry skin
  • Itching, which may be severe, especially at night
  • Red to brownish-gray patches, especially on the hands, feet, ankles, wrists, neck, upper chest, eyelids, inside the bend of the elbows and knees, and in infants, the face and scalp
  • Small, raised bumps, which may leak fluid and crust over when scratched
  • Thickened, cracked, scaly skin
  • Raw, sensitive, Swollen skin from scratching

Atopic dermatitis most often begins before age 5 and may persist into adolescence and adulthood. For some people, it flares periodically and then clears up for a time, even for several years.

What are the causes for atopic dermatitis?

Healthy skin helps retain moisture and protects you from bacteria, irritants and allergens. Eczema is related to a gene variation that affects the skin's ability to provide this protection. This allows your skin to be affected by environmental factors, irritants and allergens.

In some children, food allergies may play a role in causing eczema.

What are the treatments for atopic dermatitis?

Atopic dermatitis can be persistent. You may need to try various treatments over months or years to control it. And even if treatment is successful, signs and symptoms may return (flare).

It's important to recognize the condition early so that you can start treatment. If regular moisturizing and other self-care steps don't help, your doctor may suggest one or more of the following treatments:

Medications

  • Creams that control itching and help repair the skin. Your doctor may prescribe a corticosteroid cream or ointment. Apply it as directed, after you moisturize. Overuse of this drug may cause side effects, including thinning skin.

    Other creams containing drugs called calcineurin inhibitors — such as tacrolimus (Protopic) and pimecrolimus (Elidel) — affect your immune system. They are used by people older than age 2 to help control the skin reaction. Apply it as directed, after you moisturize. Avoid strong sunlight when using these products.

    These drugs have a box warning about a potential risk of cancer. But the American Academy of Allergy, Asthma & Immunology has concluded that the risk-to-benefit ratios of topical pimecrolimus and tacrolimus are similar to those of most other conventional treatments of persistent eczema and that the data don't support the use of the box warning.

  • Drugs to fight infection. Your doctor may prescribe an antibiotic cream if your skin has a bacterial infection, an open sore or cracks. He or she may recommend taking oral antibiotics for a short time to treat an infection.
  • Oral drugs that control inflammation. For more-severe cases, your doctor may prescribe oral corticosteroids — such as prednisone. These drugs are effective but can't be used long term because of potential serious side effects.
  • Newer option for severe eczema. The Food and Drug Administration (FDA) has recently approved a new, injectable biologic (monoclonal antibody) called dupilumab (Dupixent). It is used to treat people with severe disease who do not respond well to other treatment options. This is a newer medication, so it doesn't have a long track record in terms of how well it helps people. Studies have shown it to be safe if used as directed. It is very expensive.

Therapies

  • Wet dressings. An effective, intensive treatment for severe atopic dermatitis involves wrapping the affected area with topical corticosteroids and wet bandages. Sometimes this is done in a hospital for people with widespread lesions because it's labor intensive and requires nursing expertise. Or, ask your doctor about learning how to do this technique at home.
  • Light therapy. This treatment is used for people who either don't get better with topical treatments or who rapidly flare again after treatment. The simplest form of light therapy (phototherapy) involves exposing the skin to controlled amounts of natural sunlight. Other forms use artificial ultraviolet A (UVA) and narrow band ultraviolet B (UVB) either alone or with medications.

    Though effective, long-term light therapy has harmful effects, including premature skin aging and an increased risk of skin cancer. For these reasons, phototherapy is less commonly used in young children and not given to infants. Talk with your doctor about the pros and cons of light therapy.

  • Counseling. Talking with a therapist or other counselor may help people who are embarrassed or frustrated by their skin condition.
  • Relaxation, behavior modification and biofeedback. These approaches may help people who scratch habitually.

Infant eczema

Treatment for eczema in babies (infantile eczema) includes:

  • Identifying and avoiding skin irritants
  • Avoiding extreme temperatures
  • Lubricating your baby's skin with bath oils, creams or ointments

See your baby's doctor if these measures don't improve the rash or if the rash looks infected. Your baby may need a prescription medication to control the rash or to treat an infection. Your doctor may also recommend an oral antihistamine to help lessen the itch and to cause drowsiness, which may be helpful for nighttime itching and discomfort.

What are the risk factors for atopic dermatitis?

The primary risk factor for atopic dermatitis is having a personal or family history of eczema, allergies, hay fever or asthma.

Is there a cure/medications for atopic dermatitis?

Atopic dermatitis, commonly called eczema, is a persistent disease; you may need long-standing treatment for these symptoms. The doctor may recommend some home remedies and hygienic practices to sort out the issue.

Cure/medications-

  • Topical creams like calcineurin inhibitors such as tacrolimus (Protopic) and pimecrolimus (Elidel) affect your immune system. They are used by people older than age 2 to help control the skin reaction.
  • Prednisolone gel is usually prescribed to control the inflammation. There is also the use of antibiotic creams to control the spread of any new infection in the area. An injectable monoclonal antibiotic like dupilumab is also utilized in some patients.
  • Apart from the drugs and specific medications, a doctor may also recommend wet therapy, cryotherapy, laser therapy, and other cosmetic treatments to treat the disease.
  • Relaxation and behavior modification by not scratching the infected area is another important cure for this particular disease.
  • However, all these treatments should be done consistently for the best results.
  • Infantile eczema is usually treated by identifying the allergy-causing external applicant, adequate moisturizing the area and also voiding extreme temperature.


Symptoms
Dry skin,Itching, which may be severe, especially at night,Red to brownish-gray patches, especially on the hands, feet, ankles, wrists, neck, upper chest, eyelids, inside the bend of the elbows and knees, and in infants, the face and scalp,Small, raised bumps, which may leak fluid and crust over when scratched,Thickened, cracked, scaly skin,Raw, sensitive, swollen skin from scratching
Conditions
Skin infection that leads to red and itchy skin
Drugs
Corticosteroid cream or ointment,Calcineurin inhibitors such as tacrolimus (Protopic) and pimecrolimus (Elidel),Oral antibiotics

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